LYMPHATIC SYSTEM

The human lymphatic system, showing the lymphatic vessels and lymphoid organs. a subsystem of the circulatory system in the vertebrate body that consists of a complex network of vessels, tissues, and organs. The lymphatic system helps maintain fluid balance in the body by collecting excess fluid and particulate matter from tissues and depositing them in the bloodstream. It also helps defend the body against infection by supplying disease-fighting cells called lymphocytes. This article focuses on the human lymphatic system. The lymphatic system can be thought of as a drainage system needed because, as blood circulates through the body, blood plasma leaks into tissues through the thin walls of the capillaries. The portion of blood plasma that escapes is called interstitial or extracellular fluid, and it contains oxygen, glucose, amino acids, and other nutrients needed by tissue cells. Although most of this fluid seeps immediately back into the bloodstream, a percentage of it, along with the particulate matter, is left behind. The lymphatic system removes this fluid and these materials from tissues, returning them via the lymphatic vessels to the bloodstream, and thus prevents a fluid imbalance that would result in the organism's death. The fluid and proteins within the tissues begin their journey back to the bloodstream by passing into tiny lymphatic capillaries that infuse almost every tissue of the body. Only a few regions, including the epidermis of the skin, the mucous membranes, the bone marrow, and the central nervous system, are free of lymphatic capillaries, whereas regions such as the lungs, gut, genitourinary system, and dermis of the skin are densely packed with these vessels. Once within the lymphatic system, the extracellular fluid, which is now called lymph, drains into larger vessels called the lymphatics. These vessels converge to form one of two large vessels called lymphatic trunks, which are connected to veins at the base of the neck. One of these trunks, the right lymphatic duct, drains the upper right portion of the body, returning lymph to the bloodstream via the right subclavian vein. The other trunk, the thoracic duct, drains the rest of the body into the left subclavian vein. Lymph is transported along the system of vessels by muscle contractions, and valves prevent lymph from flowing backward. The lymphatic vessels are punctuated at intervals by small masses of lymph tissue, called lymph nodes, that remove foreign materials such as infectious microorganisms from the lymph filtering through them. In addition to serving as a drainage network, the lymphatic system helps protect the body against infection by producing white blood cells called lymphocytes, which help rid the body of disease-causing microorganisms. The organs and tissues of the lymphatic system are the major sites of production, differentiation, and proliferation of two types of lymphocytesthe T lymphocytes and B lymphocytes, also called T cells and B cells. Although lymphocytes are distributed throughout the body, it is within the lymphatic system that they are most likely to encounter foreign microorganisms. The lymphatic system is commonly divided into the primary lymphoid organs, which are the sites of B and T cell maturation, and the secondary lymphoid organs, in which further differentiation of lymphocytes occurs. Primary lymphoid organs include the thymus, bone marrow, fetal liver, and, in birds, a structure called the bursa of Fabricius. In humans the thymus and bone marrow are the key players in immune function. All lymphocytes derive from stem cells in the bone marrow. Stem cells destined to become B lymphocytes remain in the bone marrow as they mature, while prospective T cells migrate to the thymus to undergo further growth. Mature B and T lymphocytes exit the primary lymphoid organs and are transported via the bloodstream to the secondary lymphoid organs, where they become activated by contact with foreign materials, such as particulate matter and infectious agents, called antigens in this context. The thymus is located just behind the sternum in the upper part of the chest. It is a bilobed organ that consists of an outer, lymphocyte-rich cortex and an inner medulla. The differentiation of T cells occurs in the cortex of the thymus. In humans the thymus appears early in fetal development and continues to grow until puberty, after which it begins to shrink. The decline of the thymus is believed to be the reason T-cell production decreases with age. In the cortex of the thymus, developing T cells, called thymocytes, come to distinguish between the body's own components, referred to as self, and those substances foreign to the body, called nonself. This occurs when the thymocytes undergo a process called positive selection, in which they are exposed to self molecules that belong to the major histocompatibility complex (MHC). Those cells capable of recognizing the body's MHC molecules are preserved, while those that cannot bind these molecules are destroyed. The thymocytes then move to the medulla of the thymus, where further differentiation occurs. There thymocytes that have the ability to attack the body's own tissues are destroyed in a process called negative selection. Positive and negative selection destroy a great number of thymocytes; only about 5 to 10 percent survive to exit the thymus. Those that survive leave the thymus through specialized passages called efferent (outgoing) lymphatics, which drain to the blood and secondary lymphoid organs. The thymus has no afferent (incoming) lymphatics, which supports the idea that the thymus is a T-cell factory rather than a rest stop for circulating lymphocytes. In birds B cells mature in the bursa of Fabricius. (The process of B-cell maturation was elucidated in birdshence B for bursa.) In mammals the primary organ for B-lymphocyte development is the bone marrow, although the prenatal site of B-cell differentiation is the fetal liver. Unlike the thymus, the bone marrow does not atrophy at puberty, and therefore there is no concomitant decrease in the production of B lymphocytes with age. Secondary lymphoid organs include the lymph nodes, spleen, and small masses of lymph tissue such as Peyer's patches, the appendix, tonsils, and selected regions of the body's mucosal surfaces (areas of the body lined with mucous membranes). The secondary lymphoid organs serve two basic functions: they are a site of further lymphocyte maturation, and they efficiently trap antigens for exposure to T and B cells. The lymph nodes, or lymph glands, are small, encapsulated bean-shaped structures composed of lymphatic tissue. Thousands of lymph nodes are found throughout the body along the lymphatic routes, and they are especially prevalent in areas around the armpits (axillary nodes), groin (inguinal nodes), neck (cervical nodes), and knees (popliteal nodes). The nodes contain lymphocytes, which enter from the bloodstream via specialized vessels called the high endothelial venules. T cells congregate in the inner cortex (paracortex), and B cells are organized in germinal centres in the outer cortex. Lymph, along with antigens, drains into the node through afferent (incoming) lymphatic vessels and percolates through the lymph node, where it comes in contact with and activates lymphocytes. Activated lymphocytes, carried in the lymph, exit the node through the efferent (outgoing) vessels and eventually enter the bloodstream, which distributes them throughout the body. The spleen is found in the abdominal cavity behind the stomach. Although structurally similar to a lymph node, the spleen filters blood rather than lymph. One of its main functions is to bring blood into contact with lymphocytes. The functional tissue of the spleen is made up of two types of cells: the red pulp, which contains cells called macrophages that remove bacteria, old blood cells, and debris from the circulation; and surrounding regions of white pulp, which contain great numbers of lymphocytes. The splenic artery enters the red pulp through a web of small blood vessels, and blood-borne microorganisms are trapped in this loose collection of cells until they are gradually washed out through the splenic vein. The white pulp contains both B and T lymphocytes. T cells congregate around the tiny arterioles that enter the spleen, while B cells are located in regions called germinal centres, where the lymphocytes are exposed to antigens and induced to differentiate into antibody-secreting plasma cells. Another group of important secondary lymphoid structures is the mucosa-associated lymphoid tissues. These tissues are associated with mucosal surfaces of almost any organ, but especially those of the digestive, genitourinary, and respiratory tracts, which are constantly exposed to a wide variety of potentially harmful microorganisms and therefore require their own system of antigen capture and presentation to lymphocytes. For example, Peyer's patches, which are mucosa-associated lymphoid tissues of the small intestine, sample passing antigens and expose them to underlying B and T cells. Other, less-organized regions of the gut also play a role as secondary lymphoid tissue. The host of secondary lymphoid organs provides a system of redundancy for antigen sampling by the cells of the immune system. Removal of the spleen, selected lymph nodes, tonsils, or appendix does not generally result in an excessive increase in disease caused by pathogenic microorganisms. However, the importance of the primary lymphoid organs is clear. For example, two autoimmune diseases, DiGeorge syndrome and Nezelof's disease, result in the failure of the thymus to develop and in the subsequent reduction in T-cell numbers, and removal of the bursa from chickens results in a decrease in B-cell counts. The destruction of bone marrow also has devastating effects on the immune system, not only because of its role as the site of B-cell development but also because it is the source of the stem cells that are the precursors for lymphocyte differentiation.